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Emory University School of Medicine
Department of Medicine

Quick Reference Guide for Emory/GA EIP Nursing Home RTI Surveillance Pilot Project

  • Logistics
  • Documentation
    Project documents and what each one is
    Document Filename What it is
    RTI Event Form Appendix A RTI Prospective Event form The form you will be filling out and turning in. Fill this out when you have an RTI event
    RTI Event Form Table of Instructions Appendix B Table of Instructions for RTI Prospective Event form A set of instructions that details how to fill out all of the fields in Appendix A.
    RTI Definitions and Algorithms to use for NHSN RTI Appendix E RTI Definitions Tables and Algorithms for Surveillance Definitions A guide to help determine which CDC RTI Diagnosis the RTI Event should be categorized as. Read through the tables and algorithms for your RTI event when you get to the “RTI Diagnosis” section of Appendix A.
    Denominator form Appendix C Denominator Form A form that records daily census and prescriptions, to be completed monthly regardless of whether there are any RTI events.
    Denominator Form Instructions Appendix D Instructions for Denominator Form A set of instructions that details how to fill out Appendix C.
Resident ID: Composed of sequentially 4 character facility ID, first three letters of last name, first 3 letters of first name, 4 digit year of birth
  • Facility ID codes: 4 character ID.
    • Resident ID Codes. 14 character ID. Composed of sequentially 4 character facility ID, first three letters of last name, first 3 letters of first name, 4 digit year of birth of resident.
    Facility Name Facility ID
    A.G. Rhodes Cobb GAAG
    Sandy Springs GASS
    Appling GAAP
    Townsend Park GATP
    Christian City GACC
    Lilburn GAPL
    Northside Gwinnett ECC GANG
  • Rules of thumb for tracking trigger events
    • 14-day rule on repeat infections: a resident may have multiple RTIs. Fill out a new RTI event form in the same resident if there is a new trigger indicating a new RTI ≥14 calendar days after previous trigger date.
    • Antibiotic Starts must be started while a resident of the facility:
      • For antibiotic starts to be a “Trigger” the start must be while a resident, or during a visit to an outpatient or acute care facility WITHOUT an overnight admission at that facility
      • For an antibiotic start, new starts occurring during acute care admissions (of at least one night) are NOT eligible for an RTI form
    • When more than one Trigger Event.
      • If you have several trigger events on the same resident, use the trigger that occurred first. If more than one occurred on the first day, choose the trigger with the highest priority.

        Hierarchy for Available Triggers:

        1. New Respiratory Tract Infection (RTI) Signs or Symptoms (New or Worsening).
        2. Laboratory Result indicating possible RTI
        3. Imaging Result indicating possible RTI
        4. Clinical Diagnoses of a RTI
        5. Antibiotic use for indication of RTI
        6. Antiviral use for possible RTI


  • Key points for filling out RTI event forms
    • 7-day “Surveillance Window”: For most clinical information of an event, look at entire 7-day period after Trigger event date (trigger event date = day 1, so 8 days total, including day of trigger).
    • Outcomes –
      • A patient is considered transferred to hospital if they are admitted for at least one night (overnight stay). As an outcome, this means “transferred=yes” if occurred during 7-day surveillance window.
      • 30-day outcome rule: For death outcome, need to wait for about a month after each trigger event to document alive/dead
  • Key points for filling out census forms
    • New antibiotic starts in facility only –
      • New start = Started while the resident is receiving care by the facility, either by physicians in the facility or by outside physicians who see the resident in an outpatient clinic or emergency department.
      • Exclude antibiotic starts by another healthcare facility prior to the resident’s admission
      • Exclude antibiotic started during a transfer to acute care-even if resident originated in your facility and was re-admitted to nursing home after > 1 day interval (i.e., an overnight admission to acute care)
    • Capture new antibiotic orders, regardless of number of doses or days of therapy, or if course not completed
  • Tentative deadlines and dates for meetings/reporting:
    • Submit census (denominator forms) by the end of the second week of the month with data for the prior month
    • Submit all RTI forms by the end of the second week of the month with RTI events that occurred 30 days or more earlier (i.e., waiting 30 days to confirm outcome variable)
    • Weekly office hours to check in are Wed 2 pm. Zoom link here: https://zoom.us/j/97359321345 (opens in a new window)